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Religion and Health–2
600
Letters to the Editor
Mayo Clin Proc, June 2002, Vol 77
Letters to the Editor
arena because clinical trials based on a scientific framework or paradigm will not help us understand the effects of spiritual interventions on health care outcomes. These interventions are based on faith and by definition require no evidence. Appropriate spiritual support must be available to all patients who desire it, the same way we provide them with a meal and a warm blanket, and the results of clinical trials and studies should have no effect on provisions for this basic need. Raising a null hypothesis that questions which, if any, spiritual intervention is best serves no purpose. The answer to this research question lies within the heart and soul of the individual, and “evidence-based medicine” plays no role here.
Religion and Health To the Editor: Recently, Aviles et al1 published the results of a randomized controlled trial on the effects of intercessory prayer on cardiovascular disease progression. I believe that both the religious and the scientific world views are legitimate, and neither needs to justify the other. This type of study is an attempt to justify religion on scientific terms and consequently does a disservice to both. Rev Harry E. Werner University Hospitals of Cleveland Cleveland, Ohio 1.
Candido J. Anaya, MD Akron General Medical Center Akron, Ohio
Aviles JM, Whelan E, Hernke DA, et al. Intercessory prayer and cardiovascular disease progression in a coronary care unit population: a randomized controlled trial. Mayo Clin Proc. 2001;76:11921198.
1. 2.
To the Editor: A recent issue of the Mayo Clinic Proceedings included 2 articles on the relationship between religion and health. Aviles et al1 reported that intercessory prayer had no significant effect on medical outcomes after hospitalization in a coronary care unit. Mueller et al,2 however, noted that most studies have shown that religious involvement and spirituality are associated with better outcomes, including greater longevity, coping skills, and health-related quality of life and that addressing the spiritual needs of the patient may enhance recovery from illness. Faith is defined as the confident belief of the truth, value, or trustworthiness of a person, an idea, or a thing. Religious faith does not rely on logical proof or material evidence. As an investigator prepares a study protocol to examine links between religion and health care outcomes, the research question should always pass the traditional “So what?” test. Imagine if the study by Aviles et al showed a better health outcome in the patients who had intercessory prayer. Would we more actively promote prayers for our coronary care patients and quote this article as “evidence”? In contrast, are we going to stand against these prayers because we have no evidence to support them? Furthermore, if the review by Mueller et al had shown that religious involvement was associated with worse health care outcomes and aggravated recovery from illness, would we shy away from these interventions because we have no evidence to support them? The answer to this question is simple: of course not. As mentioned in the editorial that accompanied these articles,3 there is growing interest in the possibility of bringing down the wall that has separated religion and medicine. This interest is shared by many of us, but we must be cautious in proceeding with this endeavor. Although I understand that humans have an almost irresistible urge to measure and quantify, I seriously question the need for further clinical research in this Mayo Clin Proc. 2002;77:600-601
3.
Aviles JM, Whelan E, Hernke DA, et al. Intercessory prayer and cardiovascular disease progression in a coronary care unit population: a randomized controlled trial. Mayo Clin Proc. 2001;76:1192-1198. Mueller PS, Plevak DJ, Rummans TA. Religious involvement, spirituality, and medicine: implications for clinical practice. Mayo Clin Proc. 2001;76:1225-1235. Koenig HG. Religion, spirituality, and medicine: how are they related and what does it mean? [editorial]. Mayo Clin Proc. 2001;76:11891191.
In reply: We agree with Dr Anaya that “appropriate spiritual support must be available to all patients who desire it, the same way we provide them with a meal and a warm blanket.” Indeed, we drew a similar conclusion in our article. We disagree, however, with Dr Anaya’s contention that research will not help us understand the effects of spiritual factors on physical and mental health for several reasons. First, many clinicians practice in the biomedical model in which physical evidence is paramount and psychosocial and spiritual factors seem less relevant. Nevertheless, patient care is much more than disease management; it involves addressing the needs of the whole patient. Methodologically sound research informs physicians of the roles psychosocial and spiritual factors play in health and how these factors should be addressed in clinical practice. Second, numerous studies have found that fewer physicians than patients describe themselves as religious or spiritual. Hence, physicians may underestimate the importance of spiritual matters to patients and may not share Dr Anaya’s view of spiritual support as a “basic need.” Research may convince skeptical clinicians of the importance of spiritual matters to patients, as well as the importance of discerning and supporting their spiritual needs. Indeed, many studies have shown patient spirituality to be an important source of coping during illness. Third, Dr Anaya questions what clinicians would do if studies of religious involvement demonstrated adverse health outcomes. In fact, a recent prospective study1 of hospitalized medi600
© 2002 Mayo Foundation for Medical Education and Research
Letters to the Editor
Mayo Clin Proc, June 2002, Vol 77
Letters to the Editor
arena because clinical trials based on a scientific framework or paradigm will not help us understand the effects of spiritual interventions on health care outcomes. These interventions are based on faith and by definition require no evidence. Appropriate spiritual support must be available to all patients who desire it, the same way we provide them with a meal and a warm blanket, and the results of clinical trials and studies should have no effect on provisions for this basic need. Raising a null hypothesis that questions which, if any, spiritual intervention is best serves no purpose. The answer to this research question lies within the heart and soul of the individual, and “evidence-based medicine” plays no role here.
Religion and Health To the Editor: Recently, Aviles et al1 published the results of a randomized controlled trial on the effects of intercessory prayer on cardiovascular disease progression. I believe that both the religious and the scientific world views are legitimate, and neither needs to justify the other. This type of study is an attempt to justify religion on scientific terms and consequently does a disservice to both. Rev Harry E. Werner University Hospitals of Cleveland Cleveland, Ohio 1.
Candido J. Anaya, MD Akron General Medical Center Akron, Ohio
Aviles JM, Whelan E, Hernke DA, et al. Intercessory prayer and cardiovascular disease progression in a coronary care unit population: a randomized controlled trial. Mayo Clin Proc. 2001;76:11921198.
1. 2.
To the Editor: A recent issue of the Mayo Clinic Proceedings included 2 articles on the relationship between religion and health. Aviles et al1 reported that intercessory prayer had no significant effect on medical outcomes after hospitalization in a coronary care unit. Mueller et al,2 however, noted that most studies have shown that religious involvement and spirituality are associated with better outcomes, including greater longevity, coping skills, and health-related quality of life and that addressing the spiritual needs of the patient may enhance recovery from illness. Faith is defined as the confident belief of the truth, value, or trustworthiness of a person, an idea, or a thing. Religious faith does not rely on logical proof or material evidence. As an investigator prepares a study protocol to examine links between religion and health care outcomes, the research question should always pass the traditional “So what?” test. Imagine if the study by Aviles et al showed a better health outcome in the patients who had intercessory prayer. Would we more actively promote prayers for our coronary care patients and quote this article as “evidence”? In contrast, are we going to stand against these prayers because we have no evidence to support them? Furthermore, if the review by Mueller et al had shown that religious involvement was associated with worse health care outcomes and aggravated recovery from illness, would we shy away from these interventions because we have no evidence to support them? The answer to this question is simple: of course not. As mentioned in the editorial that accompanied these articles,3 there is growing interest in the possibility of bringing down the wall that has separated religion and medicine. This interest is shared by many of us, but we must be cautious in proceeding with this endeavor. Although I understand that humans have an almost irresistible urge to measure and quantify, I seriously question the need for further clinical research in this Mayo Clin Proc. 2002;77:600-601
3.
Aviles JM, Whelan E, Hernke DA, et al. Intercessory prayer and cardiovascular disease progression in a coronary care unit population: a randomized controlled trial. Mayo Clin Proc. 2001;76:1192-1198. Mueller PS, Plevak DJ, Rummans TA. Religious involvement, spirituality, and medicine: implications for clinical practice. Mayo Clin Proc. 2001;76:1225-1235. Koenig HG. Religion, spirituality, and medicine: how are they related and what does it mean? [editorial]. Mayo Clin Proc. 2001;76:11891191.
In reply: We agree with Dr Anaya that “appropriate spiritual support must be available to all patients who desire it, the same way we provide them with a meal and a warm blanket.” Indeed, we drew a similar conclusion in our article. We disagree, however, with Dr Anaya’s contention that research will not help us understand the effects of spiritual factors on physical and mental health for several reasons. First, many clinicians practice in the biomedical model in which physical evidence is paramount and psychosocial and spiritual factors seem less relevant. Nevertheless, patient care is much more than disease management; it involves addressing the needs of the whole patient. Methodologically sound research informs physicians of the roles psychosocial and spiritual factors play in health and how these factors should be addressed in clinical practice. Second, numerous studies have found that fewer physicians than patients describe themselves as religious or spiritual. Hence, physicians may underestimate the importance of spiritual matters to patients and may not share Dr Anaya’s view of spiritual support as a “basic need.” Research may convince skeptical clinicians of the importance of spiritual matters to patients, as well as the importance of discerning and supporting their spiritual needs. Indeed, many studies have shown patient spirituality to be an important source of coping during illness. Third, Dr Anaya questions what clinicians would do if studies of religious involvement demonstrated adverse health outcomes. In fact, a recent prospective study1 of hospitalized medi600
© 2002 Mayo Foundation for Medical Education and Research